This application relates to a spreader for the atrium of the heart.
In heart surgery, minimally invasive surgical techniques have become increasingly common. In particular, in the surgical treatment of the mitral valve and the tricuspid valve, minimally invasive surgical procedures play an important role. In these procedures, the surgeon accesses the heart by way of a small anterolateral incision of a few centimeters between the ribs without opening the sternum. A rib spreader, also referred to as rib retractor, keeps the ribs apart in order to keep an access to the heart open.
In surgeries of the cardiac valve, particularly in the frequent surgery of the mitral valve, first the atrium is opened up, the left atrium in mitral valve surgery. In order to maintain unobstructed view of, and access through the atrium to the mitral valve for the surgeon, spreaders, also referred to as retractors, which hold the atrial roof and the surrounding soft tissue back, are used in order to expose the mitral valve for the surgical procedure.
Such spreaders can be conventional wound hooks, wherein several wound hooks each having a rod-shaped handle are used. From WO 2008/098616 A1 it is known to use a retractor instead of individual separate wound hooks, which at the distal end of a rod carries a sheet-shaped clamp, to which a second blade is articulated in a pivotable manner. The retractor is introduced into the opened atrium with its blades folded, whereupon the two blades of the clamp are opened up so that they are approximately at a right angle to one another. The two blades of the clamp make it possible to both elevate the atrial roof and also to hold the soft tissue back in a caudal direction. However, the two blades positioned at a right angle to one another only bring about a spreading and holding back of half of the circumference of the field of vision, and of the instrument access to the mitral valve.
From US 2007/0038032 A1, a spreader from the atrium of the heart is known, wherein an elastic flat material is bent into a hollow retractor body, the diameter of which increases from a distal edge to a proximal edge. The retractor body is provided with an open slot extending axially in a surface line. The longitudinal edges facing one another and delimiting the gap can be pushed together, against one another and overlapping one another, against the elasticity of the material, as a result of which the retractor body assumes a cylindrical shape having a smaller diameter. In this rolled-up form with a small diameter, the retractor body can be introduced into the opened atrium. If the retractor body is then released, it expands into its funnel-shaped form in order to spread the tissue and to keep the operating field open. At the distal edge, the overlapping longitudinal edges of the retractor body are held together by way of a button-hole connection. The proximal edge can be held together by way of two rods, or by a clamp. The purpose of the rods, that is, the clamp, is to insert the retractor body into the atrium and will have to be removed after the insertion in order not to obstruct the view and the surgical process. After removal of the rods, that is, the clamp, the retractor body is therefore unsecured in its position in the atrium.